Is going "gluten-free" just a fad?

I remember when my great-aunt Sally came to visit, she would often bring her own bread and a tub of margarine or stick of butter. If we went out to eat to a place like Pizza Hut, she would order a salad with no croutons. When the salad arrived with croutons, she would send it back and have them remake it without them. Aunt Sally had celiac disease; a condition that damages the lining of the small intestine, causing malabsorption of nutrients after a protein called “gluten” is consumed. Even the tiniest crumb of a gluten-containing food caused Aunt Sally a lot pain.

How common is celiac disease?

An estimated 1% of the population in the United States has celiac disease, and 97% of those affected by celiac disease are undiagnosed. In Florida, that means approximately 195,000 people have celiac disease, but fewer than 6,000 of them know it. In one study looking at the prevalence of celiac disease in the U.S., 29 of the 35 people found with celiac disease did not know they had it prior to the study.

There are many common symptoms of celiac disease including: gas or bloating, diarrhea, constipation, fatigue, poor weight gain or failure to thrive in children, weight loss in adults, and thin bones. The only known treatment for celiac disease is following a gluten-free diet for life, to help prevent or resolve nutrient deficiencies, prevent stomach or intestinal cancer, and reduce infertility. Following a gluten-free diet may also help prevent the development of other conditions, such as type 1 diabetes or connective tissue disorders.

What is gluten, and where is it found?

Gluten is a group of proteins that are found in wheat, barley, and rye, and that provide the structure to baked goods, such as bread, muffins, cakes, and cookies. There are many different forms of these grains that must be avoided on a gluten-free diet, including: spelt, kamut, faro, durum, semolina, triticale, atta, wheat bran, couscous, graham flour, matzo, wheat germ, cracked wheat, farina, tabbouleh, malt, malt flavoring, malt extract, malt syrup, and malt vinegar. There are many ingredients found in our foods that contain gluten as well, including: soy sauce, malt vinegar, seasoning, marinades, and broth. Oats may be cross-contaminated and are not safe unless they say “gluten-free” on the label.

The "gluten-free" diet. Is it just a fad?

In recent years, going “gluten-free” has become very popular, and there are many people who insist they feel much better without gluten. Well, they may be right. There has been an increase in recognition of non-celiac gluten sensitivity in recent years. Non-celiac gluten sensitivity is a diagnosis of exclusion that occurs after a patient has had negative tests for celiac disease, wheat allergy has been excluded, and their symptoms improve on a gluten-free diet.

Elimination of gluten is also popular in the world of autism spectrum disorders (ASD), in the form of a “Gluten-Free, Casein-Free” diet. There is not much research at this time to support its use, but anecdotal evidence suggests that this diet could help the child pass normal, formed stools, decrease hyperactivity and increase focus, and help behavioral problems.

If you are thinking of going "gluten-free," or wonder if your child should, there are some things you should consider first:

Do you have any relatives with celiac disease? It is known to be a genetic condition. Therefore, the whole family should be tested if someone is positive.

Have you (or your child) been tested for celiac or wheat allergy already? Celiac disease may not be detected if you are already on a gluten-free diet.

Have you spoken with a dietitian about how to meet your or your child’s nutritional needs without gluten-containing foods? Despite the bad rap they get in the press, gluten-containing grains contain essential nutrients including thiamin, riboflavin, niacin, folate (B-vitamins), iron, magnesium, selenium and fiber. Non-gluten containing grains do not contain the same amounts of these nutrients.

What is your goal in consuming a gluten-free diet? This diet has become popular in large part to assist with weight loss. It may help some lose weight if they are choosing to consume more low-calorie, nutritionally dense foods to replace gluten, such as fruits and vegetables. But if they substitute their favorite wheat-containing foods with gluten-free versions, they may find the opposite will happen. Many “gluten-free” alternatives, such as pizza or cookies, are higher in calories and lower in nutrients than the wheat-based originals.

It is possible to have a healthy, nutritionally adequate diet when avoiding gluten, but it takes a lot of education and planning. This diet may not be the best choice for the average person, but it is essential for those with celiac disease or non-celiac gluten sensitivity. If you or your child will be following a gluten-free diet, ask your doctor for a referral to a registered dietitian to help you with the ins and outs of meeting your special nutrition needs.